Andrew Frazer, a consultant emergency nurse at Newham University hospital in London. Photograph: David Levene for the Guardian

Andrew Frazer qualified as a nurse in 1996 and now works at an east London hospital. Previously, he worked for the army, in the intelligence corps ("It's not as interesting as it sounds") and as a croupier ("That actually was quite interesting").

It's an incredibly sick population, he points out with enthusiasm. "Do you know why I left Chelsea and Westminster? Because I was bored, mainly because we didn't have patients who were properly sick. Anybody who had chest problems or cancer problems had their own doctor. Here, all day long, sick as dogs."

Newham's resuscitation unit is one of the largest in London – the area has a pathological peculiarity beyond the fact of its relative deprivation (life expectancy is eight years less than it is in Chelsea and Westminster).

"We also have a large percentage of patients from the Asian subcontinent in our borough. They have smaller coronary arteries and that, coupled with the fact that they eat clarified butter for breakfast, gives us a population that has more heart attacks."

Frazer runs the emergency department; his wife runs the urgent care centre, which is sited in the same place. They're run by two different bodies, the upshot of one of those complicated bidding processes that already exists in the name of the NHS marketplace.

You couldn't say that this results in a huge breakdown of communication, given that they're married; but he believes in integration, and notes in an understated way that putting things out to tender doesn't make things more integrated. So that is his first worry about the NHS bill.

Another worry is the private patient cap – originally, the bill involved totally scotching the current cap on the number of private patients in an NHS hospital. The Lords, battling for changes, put forward a cap of 3%. At the last count, they were voting on 49%, which will change the face of many, probably all hospitals.

"If they do away with the cap, what's to stop the good hospitals, like the good universities, saying, we will charge x amount. That leaves patients without access to that centre of excellence, and it leaves the surrounding hospitals having to soak up the patients who can't afford it."

I ask if he knows anyone who's in favour of the reforms. "I don't. As extraordinary as that may seem, I'm not being disingenuous. I really haven't spoken to anybody who's in favour of this."

When Frazer first joined, it was not unusual to finish your shift, come back 12 hours later and see the patient you checked in still waiting to see the doctor. So life in an emergency department, since the introduction of the four- hour waiting target, has improved enormously.

This focus on the patient as consumer has meant "there has been possibly been a lessening of respect for the medical services", but he immediately points out the patients at Newham are grateful to be cared for.

"There was such a sense of entitlement at Chelsea and Westminster – I pay my taxes and I am entitled to this. I pay your wages. Here, it's a very different environment." We leave the office we're squatting in and beetle back down the corridor, where there's a young guy with a sore leg and an angry girlfriend.

Frazer stops: "Is it still painful?" "He's in agony." "Give me five minutes." Five minutes later, we're back in the unit, prescribing some painkillers (nurses have the same prescription formulary as doctors now, with the exception of some controlled drugs). The look on the man's face makes its own point about respect.

Even professionals find the health and social care bill confusing. Below, as an introduction to this special series of interviews, Denis Campbell, the Guardian's health correspondent, explains what will happen if it goes through